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Malaysia (Selangor, Melakar)  Hand, Foot and Mouth Disease
Thirtyfive cases of hand, foot, and mouth disease (HFMD) were detected
in children between the ages of three and five years old in Selangor,
Malaysia during January to March 2002. Four of the children were admitted
to hospital and the others received outpatient treatment. No complications
were reported in any of the cases, but the Health Department continues
to monitor the situation. According to the Selangor Health Committee,
health authorities have been instructed to report HFMD cases to the
state Health Department and government hospitals have been advised
to be on the alert for cases. Private clinics are required to refer
cases to the hospitals, as clinical diagnosis alone is not sufficient
to verify the ailment. The virus associated with the outbreak, Coxsackie
virus A16, causes a mild form of the disease where patients usually
recover in approximately seven to 10 days without medical treatment.
The disease is spread mainly through feces contaminated food and water
or airborne secretions produced from the mouth or nose of patients.
The symptoms of HFMD include fever, sore throat, and sometimes blistering
rashes on the hands and feet. Cases of Enterovirus 71 (EV71) infection,
which may cause inflammation of the brain membrane and brain, have
not been detected in Malaysia.

In Malacca, Malaysia 10 cases of suspected HFMD have been reported
in children less than seven years of age, as of 09 April 2002. According
to the State Human Resource, Health, and Consumer Affairs Committee,
cases were admitted to private and government hospitals for one to
two days for observation before being discharged. The state is closely
monitoring all suspected cases.
[Promed 04/09/02]

Japan  Newcastle Disease
According to the Animal Health Division of the Ministry of Agriculture,
Forestry, and Fisheries, an outbreak of Newcastle disease has been
reported in Kamikita Gun, Aomori Prefecture in Tohoku, Japan in commercial
chicken flocks. The first case was detected on 26 Mar 2002, but the
origin of infection is still under investigation. According to reports,
no chickens on the infected farms had been vaccinated against the
disease. A total of 336 chickens have been destroyed and there have
been 119 cases, all of which have died. Diagnosis was made using hemagglutination
inhibition test and Polymerase Chain Reaction (PCR) at the Towada
Livestock Hygiene Service Center in Aomori Prefecture. Control measures
for the outbreak have included sanitization of the infected premises,
destruction and burial of chickens on the infected farms, and supervision
of a commercial flock within a 5km radius of the farms. Isolation
of the virus and pathological examinations are under way.
[Promed 04/10/02; OIE Disease Information 04/12/02, volume 15, no.
15]

Australia (Tasmania)  Ross River Virus Infection
According to officials, 37 cases of Ross River virus have been reported
in Tasmania for the year 2002, as of 10 April 2002. Only 12 cases
were reported in 2001. The virus, which is transmitted by both day
and nightbiting mosquitoes, causes a wide variety of symptoms including
headaches, muscle pain, rashes and fever. In addition, the virus may
cause polyarthritis. Travelers and citizens have been advised to use
insect repellent, keep their homes secure, and wear longsleeved shirts
and long trousers in order to avoid being bitten by mosquitoes.
[Promed 04/10/02]

Australia (Melbourne)  Influenza A Outbreaks
The Australian Department of Human Services has investigated two recent
unseasonable outbreaks of influenza A involving vaccinated residents
in agedcare facilities in Melbourne, Australia. An initial diagnosis
of influenza A (H3N2) was made by the Victorian Infectious Diseases
Laboratory (VIDRL) based on respiratory multiplex Polymerase Chain
Reaction (PCR) assays of throat and nose swabs.

The first outbreak occurred in January 2002 in a hostel where 23
cases were identified by means of laboratory confirmation and two
cases were suspected. Nineteen (45%) of the hostel residents and six
(21%) of the staff members were identified as cases. A total of 10
residents were hospitalized and there were no deaths. Thirtyeight
(90%) of the residents and two (7%) of the staff members had been
vaccinated.

The second outbreak occurred in March 2002 in a nursing home in which
16 cases were laboratoryconfirmed and 12 cases were suspected. Fifteen
(47%) of the residents and 10 (36%) of the staff members were identified
as cases. A total of three staff members and seven residents were
hospitalized, one of whom died due to influenza infection. Vaccination
histories had been collected on 20 residents and all staff. Eighteen
(90%) of the residents with a known history and three (10%) of the
staff members had been vaccinated.

The World Health Organization (WHO) Collaborating Center for Reference
and Research on Influenza in Melbourne, Australia performed analyses
and determined that both outbreaks were due to influenza A(H3N2) strains
that were antigenically related to the current and 2001 A/Moscow/10/99
(H3N2)like vaccine component as well as genetically similar to the
recent strains circulating worldwide. According to analyses, the two
outbreaks did not have a common source.
[Promed 04/09/02]

New Zealand  Hepatitis A
Health officials in New Zealand have issued a warning on the consumption
of blueberries bought between 23 December 2001 and 31 January 2002.
The health warning stated that berries bought during this time period
posed a potential risk and, even if frozen, should be discarded or
cooked thoroughly, preferably by boiling, before being eaten. An investigation
into an unusually high number of hepatitis A cases in Auckland found
17 of 29 cases since January 2002 were linked to blueberries. According
to the DirectorGeneral of Health, berries distributed under the Waikato
Blueberries brand could be contaminated with hepatitis A virus. It
is now known that a person with the highly contagious virus was at
Marshmeadows Farm during part of the harvesting period and some of
the berries linked with the Auckland cases were from this farm. The
Ministry has been working with the blueberry industry to provide detailed
information on what products might be affected, how they could be
identified, and where they were sold.

Symptoms of this most common form of viral hepatitis include nausea,
vomiting, fever, stomach ache, loss of appetite, and jaundice. Foodborne
transmission of hepatitis A virus often occurs due to preparation
of uncooked foods or harvesting of produce by an infected individual.
The majority of hepatitis A transmissions occur by the fecaloral
route.
[Promed 04/14/02]

AMERICAS

United States (Virginia, North Carolina)  Avian Influenza
The United States Department of Agriculture (USDA) has confirmed the
presence of a low pathogenic H7N2 avian influenza virus in turkey breeder
flocks and meat turkey flocks in Virginia and North Carolina. Neither
Virginia nor North Carolina has had a "highly pathogenic"
strain of the virus. The virus, which is not an OIE List A disease,
was first detected in midMarch 2002 and has been detected in 19 turkey
flocks and one flock of broiler chickens. As of 03 April 2002, a total
of 61,000 birds have been destroyed and health officials plan to destroy
another 235,000 birds. Both states have decided to depopulate the flocks.

The USDA, Animal and Plant Health Inspection Service (APHIS), Veterinary
Services (SV) has been assisting Virginia and North Carolina with
tracing the source of infection for the outbreak, aiding in final
laboratory diagnostic typing of virus isolates, and handling of international
trade consequences of the outbreak. Currently, the source of the virus
is not known, but it is thought that the virus did not come from wild
birds. Sequence analysis has shown that the isolates are most similar,
but not identical, to H7N2 viruses that have been isolated in the
livebird markets.
[Promed 04/06/02, 04/09/02, 04/11/02]

United States (Texas)  Yellow Fever
On 16 March 2002 an unvaccinated 47yearold male from Texas died
from yellow fever after returning from a fishing trip to Manaus, Brazil
in early March 2002. Onset of symptoms occurred on 10 March 2002 and
the traveler was hospitalized on 12 March 2002.
[Weekly Epidemiological Record, World Health Organization 04/12/02]

United States  Transmissible Spongiform Encephalopathy
In March 2001 a flock of 125 sheep from a Vermont farm were confiscated
by the USDA and tested for a transmissible spongiform encephalopathy
(TSE) after four animals from an associated flock tested positive
in July 2000. In 2001 the sheep were transported to the USDA's National
Veterinary Services Laboratories (NVSL) in Iowa, where they were euthanized
and tissue samples were collected for diagnostic testing. On 11 April
2002 the US Department of Agriculture (USDA) announced the confirmation
of positive test results for an atypical undifferentiated TSE of foreign
origin in two of the sheep tested in 2001. The USDA will continue
to conduct additional tests to determine the type of TSE in these
sheep.

According to the USDA's Animal and Plant Health Inspection Service,
none of the confiscated sheep had entered the animal or human food
supply. According to reports, as part of USDA's scrapie control efforts
the sheep, which were imported from Belgium and the Netherlands in
1996, were placed under federal restrictions when they entered the
United States. In 1998, the USDA discovered that it was likely the
sheep from Europe had been exposed to feed contaminated with bovine
spongiform encephalopathy (BSE). At that time, the state of Vermont
imposed a quarantine that prohibited slaughter or sale for breeding
purposes on these flocks.
[Promed 04/12/02]

2. UPDATESJapan  BSE
It has been reported that on 11 April 2002 an official from the Japanese
Agriculture, Forestry, and Fisheries Ministry estimated the damage to
farming and related industries due to bovine spongiform encephalopathy
(BSE) to be more than 365 billion yen (USD 2.73 billion). The estimate
approximates the damage caused between Sept 2001, when BSE was first
confirmed in Japan, and February 2002. During that time period revenues
at farms are thought to have declined by 131 billion yen (USD 992 million)
from a year before and sales by meatselling industries are estimated
to have declined by 160 billion yen (USD 1.21 billion). In addition,
sales of beef barbecue restaurants have declined by approximately 74
to 90 billion yen (USD 560 to 681 million).
[Promed 04/15/02]

3. NOTICESHealth Canada Orders Withdrawal of Dura Mater Grafts
On 11 March 2002 the Canadian Health Ministry suspended the license
for Tutoplast Dura, the last dura mater graft on the market. The use
of these grafts, which are made from human corpses, has been banned
by Health Canada because of concern that they may spread CreutzfeldtJakob
Disease (CJD). In addition, the government has requested that physicians
place any supplies they may have in a secure place. The graft is used
to repair the brain's dura mater as well as for other operations such
as shoulder surgery and bladder lifts. It has been associated with at
least one CJD death in the United States, prompting a Canadian review
of the product.

Recently the Canadian Neurosurgical Society estimated that surgeons
used the Germanmade dura mater grafts for about 200 patients a year.
Lyodura, another brand of these grafts that had its license revoked
in 1987, has been linked to approximately 115 CJD deaths worldwide,
including four deaths in Canada. Production methods of the Lyodura
grafts associated with these deaths differed from that of other dura
mater graft producers.
[Promed 04/12/02]

Chinese Estimates of HIV Carriers
The Chinese government announced on 11 April 2002 that the number
of confirmed AIDS cases in China is approximately 200,000, 17% above
the figure announced in mid, and that the estimate of people
infected with HIV is 850,000, an estimate more than 40% higher than
the previous. In addition, it is thought that approximately 100,000
people might have died from the disease. By the end of 2001, the Ministry
of Health had recorded 30,736 people with HIV, among whom 1,594 had
AIDS and 684 had died of the disease. Unofficial estimates by Chinese
health officials for the number of HIV carriers in China have risen
steadily from 400,000 in 1999 to 500,000 in 2000 and 600,000 in 2001.
Authorities believe China's official AIDS statistics are far lower
than the true figure because of poor reporting by local health officials.

Needlesharing among intravenous drug users accounted for 68% of
confirmed HIV cases, while illegal blood transfusions accounted for
9.7% and unsafe sex 7.2%. Beijing went public with its fight against
AIDS last year after state media exposed the spread of the virus in
rural Henan province, where farmers sold their blood to purchasing
stations. In the village of Wenlou in the central province of Henan,
43% of people who sold blood are infected, according to a statement
by the Deputy Health Minister in August 2001. China held its first
AIDS conference in November 2001, and a stateowned pharmaceutical
company announced plans to produce lowcost antiAIDS drugs. Despite
increased openness by health officials at the national level, many
local leaders are accused of suppressing information about the disease
for fear of acknowledging prostitution or drug trafficking in their
areas.
[Reuters Health Online 04/11/02; SEAAIDS 04/12/02]

Meningitis Vaccine
A team of British scientists, led by Andy Gorringe, is developing
a vaccine to combat meningitis B and C based on the harmless bacterium
Neisseria lactamica. Scientists at the government's Center for Applied
Microbiology and Research in the United Kingdom reported that early
tests of their prototype vaccine have proven effective. Laboratory
and animal studies have been completed, but the vaccine is still in
preclinical studies. The scientists began researching N. lactamica
because people who carry the bacterium seem to have protection against
meningitis B. The researchers hope to develop it into a nasal spray
for young children and, according to reports, the vaccine may also
be effective against septicaemia. Findings will be presented at a
meeting of the General Society for Microbiology in Britain.
[Reuters Health Online 04/10/02]

Certain Cosmetics Banned in China Due to Fear of BSE
On 12 March 2002 China placed a ban on the import and sale of substances
that could cause bovine spongiform encephalopathy (BSE) from 18 countries
unless they could prove that their products were free from ingredients
extracted from cow and sheep offal and tissue. The countries affected
include: Austria, Belgium, Britain, Denmark, Finland, France, Germany,
Holland, Ireland, Italy, Japan, Liechtenstein, Luxembourg, Oman, Portugal,
Slovakia, Spain, and Switzerland.

The Chinese ban comes one month after the European Union (EU) blocked
imports of Chinese meat and seafood products because they contained
what were considered harmful antibiotics. As of 04 April 2002, Beijing
customs authorities have seized 177 items of cosmetics from Japan
and Europe that were produced in France, Britain, Italy and Japan.
While many department stores in Beijing have discontinued the sale
of restricted products, others in smaller markets are reportedly continuing
until they receive a list of specified imports to pull. According
to reports, a ministry official said that the list would not be distributed
until after 20 April 2002. The estimated sale of cosmetics from the
affected countries is more than one million US dollars a year, according
to Chinese officials.
[Reuters Health Online 04/10/02]

AIDS Vaccine Combo Enters Second Human Testing Phase
Two AIDS vaccines, a naked DNA formulation and one constructed from
a weakened poxvirus, have proven safe and well tolerated in 26 volunteers
of a Phase I trial that began in August 2000. The vaccines are being
tested as a combination by the International AIDS Vaccine Initiative
(IAVI) in the United States, the Kenya AIDS Vaccine Initiative, and
the British Medical Research Council. These vaccines will be tested
on larger numbers of British volunteers in the second stage of clinical
development. Phase I/II studies have begun at Imperial College of
Science, Technology and Medicine and will soon begin in Oxford. Studies
of the vaccine combination also started in Kenya in March 2001 and
Phase II trials are expected to begin in Africa by the end of 2002.
The vaccines, which are among more than six being developed with IAVI
support, are designed to offer protection against strains of HIV predominant
in east Africa (specifically HIV subtype A). The DNA vaccines were
produced for testing by Cobra Pharmaceuticals Ltd. in the UK and Impstoffwerk
Dessau Tornau of Germany produced the poxvirus vaccines.
[Reuters Health Online 04/05/02]

Vaccine Shortage
During a recent meeting sponsored by the United Nations Children's
Fund (UNICEF), health and finance ministers were warned of a serious
shortage of children's vaccines. The conference, which had the goal
of mapping strategies to ensure stable vaccine financing and uninterrupted
supplies, was held in Cape Town on 12 April 2002 and was attended
by health and finance ministers from Africa, Asia, Latin America,
and Eastern Europe.

The survival of three million children each year has been attributed
to vaccination programs. However, according to the UN's Children's
Fund (UNICEF) an additional three million children die because they
cannot receive the needed vaccines. In addition, 10 of 14 vaccine
manufacturers partially or totally stopped production of children's
vaccines between 1998 and 2001. According to UNICEF, this is because
vaccine manufacturers want a commitment long in advance of delivery
date, but some countries cannot make such a commitment because funding
is often set on an annual basis. Vaccine shortages threaten the success
of the worldwide campaign to eradicate polio by 2005, according to
a UNICEF spokeswoman.
[Reuters Health Online 04/12/02]

Ban on Import of Thai Prawn Fry in Malaysia
The state of Kelantan in northern Malaysia announced a ban on the
import of prawn fry from Thailand on 9 April 2002 after an outbreak
of white spot disease (WSD) at breeding ponds in the country. According
to the Kelantan fisheries department, initial investigations revealed
that Thai prawns brought into the country were infected with WSD.
The disease, which was first reported in Japan in 1993, causes premature
death in crustaceans and is characterized by high and rapid mortality.
It is caused by white spot syndrome virus (WSSV) or white spot virus
(WSV) and is one of three crustacean diseases reportable to the OIE.
The virus has resulted in losses of almost two million ringgit (USD
526,316) after some 400,000 fry from 87 breeding ponds in Malaysia's
northwestern Kedah state were recently infected.
[Promed 04/09/02]

XIV International AIDS Conference 2002
Information on the upcoming International AIDS Conference being held
in Barcelona, Spain from 7㪤 July 2002 is available at: http://www.aids2002.com/IE_Home.asp.
The theme of the conference, which will consist of satellite meetings,
plenary sessions, workshops, and poster presentations, is "Knowledge
and Commitment for Action". Advance registration is closes on
01 May 2002 and registration forms are available online.

4. JOURNAL ARTICLESOral Cholera Vaccine Effective in Human Tests
A study in the April issue of Infection and Immunity by Dr. Cohen and colleagues
of Children's Hospital Center in Ohio, United States tested a new oral vaccine
against cholera called Peru㪧 in 59 healthy volunteers. The existing vaccine
available for preventing cholera is given by injection, and protects about
half of people who receive it and produces adverse reactions at the injection
site and throughout the body. In the study volunteers received either the
vaccine, made from live, weakened Vibrio cholerae bacteria, or an inactive
placebo shot. Approximately three months later 36 volunteers were exposed
to live V. cholerae bacteria.

Headache and abdominal cramps were reported more often with the Peru㪧
vaccine than with the placebo, but the occurrence of abdominal cramps
was not statistically significant. All but one person who received the
vaccine (97%) showed at least a fourfold increase in the amount of anticholera
antibodies in their blood. When exposed to the cholera germ, five (42%)
individuals in the placebo group and none of the 24 individuals in the
vaccine group developed moderate or severe cholera. Seven placebo recipients
(58%) and one (4%) person recipient of the vaccine reported any diarrhea.
According to Reuters Health, investigators plan on conducting a larger,
multicenter challenge study to replicate the results obtained using a
production lot of the vaccine. The length of time that the new vaccine
protects against Cholera has yet to be determined.
[Infection and Immunity 2002;70:1965 Reuters Health Online 04/08/02]

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